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  • Q&A with Australian Health Practitioners

    Frozen shoulder - what are my treatment options?

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    Musculoskeletal Health Orthopaedics
    My ortho advised me to have hydo.... not sure how to spell it. When they flood the joint with saline. I'm not keen on having that done under ultrasound. What else can be done. I've tried physio, anti-inflammatories. Have had an ultrasound which results were slight tear in rotar cuff, now it is frozen. This has been going on for nearly 6 months. Please help with other options
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    Anca Maria

    HealthShare Member

    Treatment for frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

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    KoKo Potter

    HealthShare Member

    Physiotherapy protocol for frozen shoulder suggests that we initially assess carefully to see whether your neck is referring pain to the shoulder, or if it is a true "frozen" shoulder where you have lost range in all directions, your night pain is severe, and your limitation is getting worse.

    Unfortunately, the pathology is thought to be an auto immune reaction post trauma or stress and there are commonly underlying rotator cuff tears (about 80% of >50 yr olds have some tears). Therefore, you need to be very patient and wait for the point where the shoulder starts to loosen. Do not continue with any treatment that is not giving you some benefit.

    Initially I would provide you with accurate information about your problem, very gentle exercises, and advice to ease pain and cope with your activities. I may see you two or three times then restart rehabilitation treatment once your pain and movement start to improve. Diagnostic ultrasound with a guided cortisone injection may help assist – speak to your general practitioner.

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    Dr Mark Haber

    Orthopaedic Surgeon

    Clinical Associate Professor Mark Haber is one of Australia's leading orthopaedic shoulder surgeons. He uses the latest shoulder arthroscopic (keyhole surgery) techniques to address shoulder … View Profile

    Firstly is can be very difficult to diagnose a frozen shoulder.

    IF it is a TRUE frozen shoulder, for many patients whose symptoms are tolerable, a wait and see approach is quite reasonable. Typically if symptoms are tolerable at the 6 months following onset, no intervention will be required.

    Physiotherapy may exacerbate the pain in the first few months following the onset of symptoms in what we call the freezing phase or the inflammatory phase of this condition. Nevertheless in the thawing phase when the inflammation has settled, physiotherapy and stretch exercises might accelerate recovery in range of motion.

    Cortisone injections reduce inflammation. For it to be effective in frozen shoulders the injection has to be performed into the glenohumeral joint, not the bursa. They can provide 3-4 weeks of symptomatic relief. As this condition is only temporary and usually at its worse for a short period, this treatment is quite effective and usually only 1 or 2 injections are required to alleviate the worse of the symptoms.

      If the symptoms do not respond well to cortisone injections and are prolonged or intolerable, an arthroscopic capsular release is a key-hole day-surgery operation in which the inflamed and thickened capsule can be released. This allows often dramatic relief in the severe pain and accelerates recovery in the range of motion.

    You can check my web site on:

    http://www.shoulderorthopaedist.com.au/shoulder-conditions/frozen-shoulder/

     

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